The charge nurse observes a nurse performing interventions for a client who has just arrived in the post-anesthesia care unit following right cataract removal and intraocular lens implantation. Which intervention would require the charge nurse to intervene?
The nurse waits 5 minutes between administering prescribed eye drops.
The nurse leaves the eye shield in place while the client sleeps.
The nurse is instructing the client not to drive at night.
The nurse encourages the client to exercise with 20 lb weights 1 day post-operatively.
The Correct Answer is D
Choice A reason: The nurse waiting 5 minutes between administering prescribed eye drops is a standard practice to allow each drop to be properly absorbed and avoid dilution of the medication. This intervention does not require any action from the charge nurse.
Choice B reason: Leaving the eye shield in place while the client sleeps helps protect the eye from potential injury or infection after surgery. This is a recommended practice and does not need intervention from the charge nurse.
Choice C reason: Instructing the client not to drive at night is a reasonable precautionary measure given the client's recent eye surgery and potential vision changes. This instruction does not warrant intervention from the charge nurse.
Choice D reason: Encouraging the client to exercise with 20 lb weights one day post-operatively is inappropriate and requires the charge nurse to intervene. Strenuous activity can increase intraocular pressure and compromise the healing process after cataract surgery. The client should avoid heavy lifting and follow the post-operative care instructions provided by the healthcare team.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Skipping a weight check post-dialysis is not recommended. Monitoring weight is crucial to assess fluid balance and effectiveness of dialysis.
Choice B reason: Warming the dialysate solution before instillation is important to prevent discomfort and cramping during the dialysis process. This ensures the solution is at body temperature.
Choice C reason: Packing the catheter exit site with gauze is not recommended. The site should be kept clean and dry, with proper sterile dressing.
Choice D reason: Avoiding foods high in potassium is more relevant for clients on hemodialysis rather than peritoneal dialysis. Clients on peritoneal dialysis have fewer dietary restrictions regarding potassium.
Correct Answer is C
Explanation
Choice A reason: Administering an extra dose of albuterol at bedtime is not appropriate. The correct approach is to manage bronchial secretions through other means, such as hydration.
Choice B reason: Using a dehumidifier is not recommended for clients with respiratory issues. A humidifier, not a dehumidifier, helps keep the air moist and can help with secretions.
Choice C reason: Increasing the amount of fluids consumed helps to thin bronchial secretions, making them easier to cough up. Hydration is an effective method to manage secretions and improve respiratory function.
Choice D reason: Increasing daily exercise can be beneficial for overall health but is not the primary method to clear bronchial secretions. Hydration is more directly effective in this situation.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
